Accuracy of low-dose rubidium-82 myocardial perfusion imaging for detection of coronary artery disease using 3D PET and
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Myocardial perfusion imaging using Rb-82 positron emission tomography (PET) is a powerful tool for diagnosing obstructive coronary artery disease (CAD) because of its consistently high accuracy.1-6 Technological improvements are incrementally improving the
See related editorial, pp. 1110–1112 From The National Cardiac PET Centre and Cardiac Research Methods Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. Received for publication Apr 11, 2012; final revision accepted Aug 28, 2012. Reprint requests: Robert A. deKemp, PhD, The National Cardiac PET Centre and Cardiac Research Methods Centre, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada; [email protected]. 1071-3581/$34.00 Copyright Ó 2012 American Society of Nuclear Cardiology. doi:10.1007/s12350-012-9621-y
diagnostic ability of PET systems, such as three-dimensional (3D) coincidence detection. 3D PET imaging poses a challenge because of increased scatter; however, this can be outweighed by advantages from the increased sensitivity and count density, which results in improved image quality and reduced patient doses.7-9 Previous studies have described the development of ‘‘normal databases’’ characterizing relative perfusion data for patients with a low-likelihood (LLK) of CAD.2,6,10-13 These databases objectively define the normal range of relative perfusion values to evaluate patients with suspected CAD and determine whether the perfusion distribution is normal or abnormal. These databases can be used as an adjunct to the subjective visual scan interpretation by the clinician. Most of the previous studies that have developed LLK normal databases have done so only in the context of SPECT or 2D PET myocardial perfusion imaging. There is a need for the development of additional LLK normal 1135
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Kaster et al Accuracy of low-dose Rb-82 MPI
databases for 3D Rb-82 PET MPI. The objective of this study is to describe the development of such a database using 3D hybrid PET-CT imaging, and evaluate its accuracy for the diagnosis of CAD. METHODS
Journal of Nuclear Cardiology November/December 2012
intervened MI (n = 7) or left ventricular ejection fraction (LVEF) \40% (n = 18) because of the known effect of cardiomyopathy on perfusion independent of obstructive epicardial coronary disease, following the methods of Bateman et al.1 History of acute intervened MI was defined as any patient treated with PCI or thrombolytics immediately following any previous MI. There were no patients with MI in the interval between PET imaging and catheterization.
Patients LLK normals. Using a record of 1,501 patients who underwent PET perfusion scans between July 2009 and December 2010 (inclusive), a group of patients with a LLK of CAD was identified. This group was created by removing any patient with the following: known CAD [i.e., previous myocardial infarction (MI), percutaneous coronary intervention (PCI), and CABG], typical or atypical angina, diabetes, and rest or stress EC
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